WHAT DOES GOOD COMPLEX CASE MANAGEMENT PRACTICE LOOK LIKE?
FOCUS ON COMPETENCY 1: COMMUNICATION
Working with a 15 year old female who has sustained a severe traumatic brain injury at 9 months of age who lives with parents and is attending a specialist school.
She struggles to make friends and has experienced significant bullying in the past with a need to change schools. Now settled into a specialist school, developing friendships remains difficult, with huge trust issues.
She does however have greater confidence in the online world and has made “friends” with individuals that she has never met. Whilst not wanting to present negatively to the development of these friendships, case manager, parents and the independent team working with X all have concerns as to how real these individuals are, concerns regarding vulnerability and potential information shared online.
To help ensure X’s safety online a number of strategies have been introduced, including IT risk management plan, a behaviour programme developed with the clinical psychologist; including allocated time online, agreement with X that parents are able to see what she is doing online, who she is talking too and X is happy for parents to be involved in the group conversations online, when present with her.
However, school undermining all the hard work and demonstrating a significant lack of understanding in supporting a young person with a brain injury or the direction of the professional team. The parents are extremely frustrated by the approach taken by the school. School’s approach, is that she is a teenager and should be developing skills to make her own choices and to learn from mistakes. When at school, the school are not as supportive of these strategies with X allowed to access all sites during the day, with no restriction on use nor monitoring of the sites visited, this leading to great conflict, both between school, professional team and parents, also X and her parents. X Unable to understand why at school she is allowed as much online access as she wishes, whereas at home this is not the case.
Case Management Actions:
- Met with client to hear her views and support her choices safely.
- MDT meeting held to provide school with further clinical reasoning as to why strategies have been introduced and encouraged to support this.
- School offered bespoke ABI training to help build upon their knowledge base and increase understanding of brain injury and reduce family frustration.
- Establish client to have the same boundaries whether at home or school and ensure her safety online as much as possible.
- Gather information regarding online sites X accessing to establish extent of client’s risk
- Supporting parents with behaviour management plan and encouraging X to engage in conversation regarding virtual conversations.
- Bespoke Education regarding X provided to school.
- Close working and communication amongst the MDT, parents, X and school to ensure collaborative approach and open dialogue. Raising issues when they arise and problem solving in a supportive manner.
Skills used from Competency 1:
1a – rapport – building relationship with client, family and significant others working with them.
1b – active listening – listening with understanding without overlaying opinion / judgement on what is being heard
1c – Skills of communication – developing the skills to facilitate the exchange of inflation
1d – Negotiation – achieving consensus in the client’s best interests.
Positive indicators evidenced:
- X has online access which can be monitored to help ensure safety online.
- X working with behaviour plan which results in rewards, relating to hobbies.
- X will inform those working with him if in trouble on line or not sure of a situation, rather than hiding this information away which could lead to difficulties in the future.
- School recognising X has an ABI and needs to be supported differently to some of their other non ABI pupils. With current approach of X learning from mistakes recognised as a method that does not work as X has forgotten what lead to the mistake the first time.
- Effective communication between professional team and Parents providing a united an supportive approach to X. One in which allows X to open up when concerned.
Bear traps avoided:
- Client disengaging as feeling as though others are taking control with the mixed messages given. With frustration and anger developing as a result.
- Another consequence is X not knowing who she can trust, both in reality and the virtual world.
- Relationship between family and school breaking down with the outcome that the child needs to move school again.
- Avoided need to safeguard child
- Maintained relationship between case manager and all active parties
Duty of care
Coordination and management
Referencing publications and legislation:
BABICM Code of Ethics and Conduct in Case Management Practice
Children and Families Act 2014
The Children Act 1989
Keeping Children Safe in Education 2021
Working together to safeguard children 2018
Although training offered at an early stage of client attending specialist school, this was not accepted with school advising it was not needed. Case manager could have pursued with another offer of training, but was fearful of offending school and a breakdown of the relationship. Repeated offering of training enabled the school to take the offer up when they were ready to engage with it.
Timing of intervention can be key in whether it is taken on board and the messages are accepted.
Persistence on behalf of the client can be required to ensure they are protected.
Case manager working closely with the professional team, X and family and although may be unpopular with suggestions made, able to evidence in supportive approach as to reasons why suggestions are made to ensure X safety and vulnerability.